P01.20.B Peroperative cognitive monitoring in patients with aphasia

Abstract

Abstract Background Cognitive monitoring during awake glioma surgery provides the opportunity to increase the extent of resection while preserving cognitive functions. Preoperative language functioning often determines whether awake surgery can be performed since some form of communication with the patient is essential. However, as complex as it may be to perform intraoperative monitoring in patients with severe preoperative language disturbances, it is risky to assume that language disturbances are definite without functional perspectives. In addition, there are other cognitive functions that should be preserved. This study investigates to what extent cognitive functions can be monitored during awake surgery in the presence of preoperative language disturbances. Material and Methods Glioma data were collected in a single-centre consecutive study cohort of 186 patients who underwent awake brain surgery for either low-grade (WHO grade 1-2) glioma (40 percent) or high-grade (WHO grade 3-4) glioma (60 percent). Preoperative language disturbances were evidenced during preoperative neuropsychological assessment based on performances on the Boston Naming Test (N= 27) and Token Test (N=25). Intraoperative procedures were performed as part of clinical care. Results Preliminary results on the Boston Naming Test show that intraoperative testing with the use of at least one language test (picture-naming) is feasible in 80 percent of all patients with language disturbances. In those cases, a functional boundary of language functions is found in 85 percent during awake surgery. Monitoring of other non-language functions, such as working memory, inhibition, speech, motor functions and social cognition, provided functional boundaries in 25 up to 85 percent of patients with language disturbances. Postoperatively, cognitive functioning was improved in a significant number of patients. Conclusion Based on these preliminary results we conclude that preoperative language disturbances do not prevent from monitoring language functions as well as other cognitive functions during awake glioma surgery. In a larger cohort, more in-depth analyses will be performed on additional outcome measures (Token test, survival rate, post-surgery treatment) and postoperative functioning will be compared to a control group of patients without preoperative language disturbances. By investigating the potential of awake surgery in patients who are severely cognitively affected, we aim to increase the applicability of this method to improve neuro-oncological treatments and optimally maintain quality of life.